Provider Demographics
NPI:1609076868
Name:KONIARCZYK, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:KONIARCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 SOM CENTER RD
Mailing Address - Street 2:WH 10 / INTERNAL MEDICINE/PEDIATRICS
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9607
Mailing Address - Country:US
Mailing Address - Phone:440-943-2500
Mailing Address - Fax:
Practice Address - Street 1:2570 SOM CENTER RD
Practice Address - Street 2:WH 10 / INTERNAL MEDICINE/PEDIATRICS
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9607
Practice Address - Country:US
Practice Address - Phone:440-943-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097075207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics